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The Article in Brief
Original and REGICOR Framingham Functions in a Nondiabetic Population of a Spanish Health Care Center: A Validation Study
Francisco Buitrago , and colleagues
Background Risk prediction models are designed to estimate the probability of a patient developing a clinical condition based on known risk factors. This study evaluates the performance of 2 long-established risk scoring mechanisms for coronary disease: the original Framingham and REGICOR Framingham mechanisms.
What This Study Found Researchers find that one scoring mechanism overestimates risk, whereas the other underestimates it. This 10-year observational study of 447 adult nondiabetic patients in Spain finds that the Framingham risk function overestimates coronary risk by 73 percent, whereas the REGICOR Framingham function underpredicts the population�s coronary risk by 64 percent. Moreover, the original Framingham function selects a greater percentage of candidates for antihypertensive and lipid-lowering therapies than the REGICOR function. The proportion of patients included in the high coronary risk category also is doubled with the original Framingham equation.
Implications
- That both models fail to accurately predict the population�s actual coronary risk in the 10-year follow-up period is not surprising to the authors. The original Framingham study was conducted before the widespread use of effective treatment for cardiovascular risk factors, so its equation currently overpredicts cardiovascular risk when applied to populations who have their risk factors actively managed.
- The authors conclude the Framingham risk mechanisms could be improved by revising them to include additional cardiovascular risk factors and variables, such as family history of cardiovascular disease in a first-degree relative, social deprivation, body mass index, and current prescription of antihypertensive therapy.